TREATMENT - Knee Meniscus Tear
Most orthopedic surgeons agree that this problem should be evaluated further with tests such as a Magnetic Resonance Imaging (MRI) as well as a very thorough history and physical exam. If your knee continues to produce pain and giving way, your physician may recommend surgery, usually an arthroscopic surgery. However, not all people with a meniscus tear require a surgery. Some people are able to live with a meniscal tear and avoid surgery if their symptoms are not too bad and depending on the exact circumstances of the tear. If you are told that you will require "conservative care" (meaning that you do not need surgery), your physician will tell you that you need to: Control, Avoid, and Rehabilitate.
Cryotherapy (i.e., ice or cold therapy) is an excellent way to control your pain. Do not apply ice directly to your skin for more than 5 minutes as it can cause burns. A device specially designed to cool your joint (see our PolarCare Cub) can be used for longer periods, as long as you carefully follow the directions and discontinue its use if you have pain or a burning sensation.
Over-the-counter pain medications can be of use. These include anti-inflammatories such as MotrinTM (ibuprofen) and AleveTM (naproxen), and pain medications, such as TylenolTM (acetaminophen).
Occassionally heat can be of benefit after the initial pain has resolved. Heat is sometimes useful to combat stiffness. You can apply a heating pad on a low setting for approximately 10-20 minutes at a time. If you do not have a heating pad, you can use a soft terry cloth hand towel placed under warm (not hot) tap water.
The use of glucosamine sulfate has been shown to benefit people with arthritis. Often people with meniscal tears, if they are "middle-aged", can have arthritis, or softening of the cartilage known as chondromalacia. As a matter of fact, the usual reason to treat someone with a meniscus tear without surgery is because they do have some component of arthritis.
Bracing. Braces provides pain relief by stimulating some of your nerve fibers which make you feel that your joint is more stable and secure. These are the same nerve fibers you compress when you grab your finger after you hit it with a hammer. Even though your finger was just smashed, you squeeze it with your other hand as hard as you can and it makes it feel better.
With a meniscus tear, bracing keeps your knee warm (to decrease your pain) and also provides stability that decreases those motions that cause increased pain (for example, side-to-side motions and twisting motions frequently make the pain of a meniscal tear worse). However, although the braces may make your knee feel more stable, your knee can still have some "giving-way". If this continues, you should see your doctor. We offer two braces to help your pain with a meniscal tear. If you like a brace that will give you significant support, try our DonJoy Drytex Hinged Knee Brace. If you just want some gentle compression and support (for a degenerative meniscus tear, for example), our DonJoy Comfort Knee Brace will suit you well. For level of knee support that is something in between, try our DonJoy Tru-Pull Advanced Hinged Patellar Knee Brace
Avoid activities that cause your pain
Just like the old bad joke about the patient that told the doctor: "Doc, everytime I do this, my knee hurts" and the doctor replies: "Well, don't do that!" Although this may seem humorous, there is some truth to the joke. Your body has developed a very complex mechanism to inform you that something is wrong. Humans that ignored these warning signs are no longer living with us today. When our great, great ancestors did not listen to this mechanism, they were killed off by disease or by predators. Thus, pain acts as a warning signal to stop, rest and do something else. Avoid such activities as squatting, kneeling, heavy lifting, climbing, and even running. Listen to your body and make a list of activities or movements that increase your pain and DON'T DO THESE THINGS. Also, make a list of activities and movements that reduce your pain and DO THESE THINGS. For example, many doctors recommend the following (be sure to check with yours to make sure he/she agrees).
DON'T DO these if you have meniscus tear:
- Twist your knee.
- Walk on uneven terrain.
- Try to sleep with your legs out straight at night instead of curling up into a ball.
Rehabilitate your knee
The key to this step is to remember controlled motions. This means you have complete control of these motions through a structured rehabilitation program. Most rehabilitation programs can be done in the convenience and privacy of your own home. If you have a meniscus tear, most of your rehabilitation will be focused on both your quadriceps (thigh muscle) and hamstrings (muscles behind your knee) muscle groups. In specific cases, your doctor may prescribe formalized physical therapy, with a therapist or trainer.
The keys to rehabilitation include
- Motivation to actually do the exercises. See our page on motivational strategies to improve your success.
- Correct exercises for your problem. See your doctor or physical therapist if you need advice in this regard.
- Proper equipment. This equipment can either be at your therapists office, at your health club, or items that you purchase for use at home. We have found that people who do their exercises at home are much more likely to benefit from the program as they more frequently perform the exercises.